This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Sunday, 5 July 2009

Funny Complaints: The Nurses Cannot Win. EVER

So I am back. I think we finally have a fully functional PC now. Fingers crossed. We had built one recently and had problems with that so finally we bought one.

To be honest I have also been having a bit of blogger block. I think have about 30 half finished posts.

I don't have a lot of time today but I thought I would check in anyway. A couple of work related incidents have made me laugh out loud this week.

A large medical ward such as mine takes a large number of elderly patients at any give me time. This means that we often take patients who have hearing loss. It also means we have a large number of extremely grumpy and self centered people. I don't care if that last sentence sounds offensive. It's true. You and I will more than likely be self centered, miserable and easily stressed over nothing when we are elderly as well. Reality. Deal with it. I don't do politically correct on this blog. The fact of the matter is that old age sucks and that it will come to most of us someday.

Let's start with the hearing loss. We obviously have more than a few patients with some type of hearing impairment. Their hearing aids are usually lost somewhere between Casualty and the medical express units. By the time they get to the ward we have a serious barrier to communication. Whiteboards and notebooks don't always work out too well due to additional problems with eyesight, crippling arthritis etc. Most of these patients have only suffered from hearing loss recently and do not use sign language. If the hearing aid is awol we will try and get audiology to sort it out. If we are lucky they will come and the see the patient about 800 years after the initial referral. That's deemed quick.

So my patient cannot hear me. I am going a mile a minute and can usually only spend 10 seconds with any patient at any given time. This is bad. The patient has no understanding of what I have on my shoulders and thinks that I am running in and out of the room without taking the time to explain things because I am an inconsiderate bitch. Yes, we know that this is what you think. I do try to explain things in the few seconds I have between dealing with the transfusion reaction in bed 4 and the fall in bed 28. Sometimes I will fly into your room to give you a much needed pain killer when I am in the middle of an emergency elsewhere. I shouldn't leave the emergencies to give a pain killer. Not ever. But if I don't use the 2 seconds I have right now to do it, before the bleeder really starts to crash, then you may not see me again for 2 hours.

Multiply this situation by about 12. Realise that often the nurses are in this situation almost at all times. due to short staffing. Then you will see why we fly in and out of the rooms to fast. We are not trying to be rude or inconsiderate. If you think I can control how long I spend with a patient your are completely crazy.

Often we are trying to communicate with our hearing impaired patients by just talking loudly and trying to help them to lip read. Sometimes it works. Sometimes I just cannot work it all out due to time constraints. Most of the time the patients in near beds will complain about the nurses "talking to loudly and disturbing them". This is especially a problem at night.

Example: Patient with hearing impairment rings bell because they have started having pain. Nurse has to ask questions. If things like notebooks etc are out of the question ...then the nurse has to speak loudly and clearly. It's not a good solution but what else can your do at 3 AM if all other options are out of the question. The rest of the patients on the ward go ballistic and threaten to "strangle that deaf bitch and the nurse". We are often trying to communicate with patients who have difficulty hearing during the night. Unfortunately you are not all in private rooms. This is not a situation that was created by the Nurse so fuck off.

On the other hand, and often at the exact same time...we get complaints about the nursing staff from hearing impaired patients. The nurses offended them by "talking too softly and quickly when she knew I was deaf" and "not taking all the time that was needed etc". The former occurs because we have multiple other patients on the ward who complain about the lack of quiet on the wards. The latter occurs because we are always rushed due to factors out of our control.

Patients in general: We are not talking loudly to piss you off. Patients with hearing impairments: we know that there are mega barriers to communication and we are really doing the best we can with the resources and time that we have. We are not being "insensitive" the the fact that you have hearing loss. Nor are we insensitive to the fact that patients really need peace and quiet. We do get that. Yes, really.

But sometimes there is just going to be a lot of noise.

I'll never forget the night that my colleague found a young patient in full respiratory arrest (but with a pulse) during her rounds at about 2 AM. I was the only other nurse and was on the complete other side of the ward. ANNNNNNNNNNNE!!!!!! The way my junior colleague screamed my name made me go cold. It was an unexpected arrest and a young patient. Then there was the chaos of the cardiac arrest, the senior docs and ITU team shouting orders. The patient survived. The next day multiple other patients complained all day long to anyone who would listen about the horrendous noise they were subjected to at 2 AM. They complained about how much they suffered and how dreadful the nurses were for disturbing them like that.

Why is there always this bad attitude and towards the nurses? Why all the assumptions that all these bad things happen because the nurses are being cruel, insensitive, inconsiderate, thick etc. The answers to those questions can be found if one studies the history of the nursing profession and the subconscious images that people have of nurses. I'll get around to finishing that post.

My children were promised a day out today. I'll try and add to this in another post later.

28 comments:

My ward is a mix of nightengale, bays and 2 side rooms. This set up causes a lack of privacy and quiet for the patients. It has detrimental effect on patient dignity no matter what the nurses do. The nurses did not design/and or agree to this set up.

Working in these conditions makes it extremely difficult...well impossible even to do everything properly for every patient at all times. It takes talent to do things as well as we do. Our actions may not always fit into the public's ridiculous, unrealistic, and nutty idealistic expectations of how everything should be on a ward. This does not meant that the nurses are indifferent, lazy, thick etc etc.

It means that the public (and nurses that have been retired for years) need a bit of education regarding the entire situation before than can make an informed opinion.

I think I am going to start a "Leave the nurses alone and take a goddamn look at the conditions that they are working in, you fucktard" group on facebook.

Or how about "For christ's sake, one nurse cannot physically feed 12 people by herself while managing critical patients at the same time or develop the powers to astroproject just because you don't want to spend money,you fucktard."

EXACTLY Anne...........sometimes i am just too tired to articulate how i feel........but i just read your post and then i understand exactly how i feel, why i feel it and i feel this huge relief that the disstress i am feeling (why do i cry suddenly when i hear my daughter singing? i just cry for no reason ect) Its because of all the frustrations you articulate so well on your blog. one day you will write a book like that woman who wrote "call the midwife". you have no time now (but you will in your old age). PLEASE keep blogging it helps us. (tell your hubby its better than having an affair or drinking alcohol)

I'm a doctor. There has been months of understaffing propped up by agency nurses (who can't even find the gauze), recruitment attempts = no one turns up at the interview, no one wants to work in gen med/elderly care. Nasty relatives criticizing (the worst are often actually other nurses). Families who hate each other so much they can't stay in the same room all abusing the staff. The only thing I can do is put an arm around the nurses who are weepy, try to cheer up the frightened/anxious ones who no senior nurse has the time to support, never tell the nurses off (difficult at times) and bring in cakes. I have tried writing to head of nursing, patient safety person, safeguarding adults person about insufficient nursing numbers....nothing happens. What can be done?

We cannot win this fight unless we open people's eyes to what is going on. The outdated images that people have of nurses are the direct cause of a lot of these problems. If people (the public, hospital business managers etc) had any kind of understanding of what the actual situation is things would change.

Until this understanding comes about all the incident forms, letters, unions etc etc will continue to be futile.

See, we are always told people behave the way they do because they are sick and in the hospital. However, they rarely shout at anyone BUT nurses.

Example: I was walking over to an angry looking man with his pills. There is an open plan dining room in our facility where he can see the kitchen. I said the usual "My name is Nurse Blah I'm taking care of you today" and he screamed at me that his breakfast was 15 minutes late. I pointed out the man who was making the breakfast and the male aide that was responsible for bringing the trays and feeding and that they would be able to help him and I'm sure it wouldn't be too much longer. More screaming. At the end of the confrontation I said "Why don't you scream at the people responsible for your breakfast? Or is it that you prefer to scream at women?" He shut up but was polite as pie to the male aide.

I've also asked people who scream at me that the doctor promised to be here in the afternoon and where is he that they could perhaps scream at the doctor in the same fashion. But they don't.

I think it's down to screaming at people that they know there will be no consequences for their actions, and it's always easier to scream at a woman than it is a man.

Do you know who nurses were in ancient times up through to victorian times? They were criminals, prostitutes,invalids and indentured servents who were forced (often with physical harm) to do the work of nursing. During the American civil war prisoners of war were forced to work as nurses in the army hospitals. It was considered a humiliating punishment. It's not as if nurses needed any kind of training or knowledge to work back then. Hell, neither did the doctors really. Medical schools were a joke back then.

In the 18th century prostitutes were forced to work as nurses in order to keep them out of trouble. I have seen one example from the 18the century but that is not the only time this occured. Even further back in history nursing was forced into people with debt problems. Basically, nursing as a job was forced onto the most undesirable members of society.

During the American civil war Dorothea Dix demanded that all her female nursing recruits be very unattractive and from poor families. Attractive women and women from good families were turned away from nursing in the army hospitals even though there was a dire need for nurses. Part of this was victorian sensibilities and part of it was maintaining the ideal of what a nurse should be.

None of those people wanted to be nurses. It was basically a humiliating punishment or indentured servitude for the poor. They had to be disciplined harshly and frequently to keep them from neglecting and harming their charges.

In the 21st century we have highly trained professionals who work in all areas of healthcare delivering complex holitistic care. These people are today's nurses and what they do is very different from being a doctor who diagnoses a disease process and prescribes a treatment. It includes the jobs that nurses did over the last few hundred years plus a million other things. Nurses assess patients and monitor their conditions. They can only do this well with a high level of training. Modern innovations have changed the way that healthcare is delivered. It's damn complicated and a far cry from the days when a STD riddled prostitute was forced to work as a nurse i.e. washing bandages.

The job of today's nurses( who take on more responsibilty and use more critical thinking skills on the job than other 3-4 year grads) is extremely complex. We can't just go to work and mop brows and wipe bums. There are millions of other things we need to follow through onas well to avoid harming or killing our patients. We are nurses.

A 21st century nurse is different from a 19th century nurse. In the 19th century "doctors" who had less training than a barber cut people's limbs off with a dirty knife and wiped it on the bottom of their shoes. People didn't think that doctors needed to be very well educated back then either. At that time doctors were considered very "beneath" proper professionals such as lawyers and writers. Hell a poet was more respected as an intelligent person than a doctor was. More on that later. With that being the case you can imagine what people though of nurses.

Nursing school is so damn tough now that you cannot make it through unless you are highly motivated and want to be there. And it needs to be that tough.

The public hasn't realised that changes in healthcare have led to changes in nursing. Their image of a nurse and people who go into the profession is still very much centred on what a "nurse" was throughout human history.

Our patients, their relatives, the public and our employers still see "nurses" as undesirables who are doing the job as a punishment. They still see nurses as undesirables who have been forced into the job, and need watching with a close eye. They may not realise it,but this kind of thinking is in the back of their minds. This kind of thinking is rooted deep down into their subconscious minds as a result of thousands of years of human history.

Oh and Nurse Anne is really very well versed in history..... Specifically 19th century american history.

I recently read a book about medicine in the 19th century (about 100 of them actually). To those people the idea of a doctor needing an education or needing to be anything but a brute with a strong stomach was laughable.

But things changed and now doctors need to be the most intelligent and best educated out of all of us in order to do their job well.

These same changes have caused the nursing profession to have to step things up as well in order to do their own jobs well. We are just about 100 years behind the docs as far as getting respect from the public.

Why have humans come around to the idea that doctors need to be well educated and intelligent to do their jobs well? The need for this only came about in the 20th century onwards. Seriously. Up until then medicine was a fucking joke and medical school was for retards.

Why do they resent nurses when changes in healthcare demand that nurses need to be smart and motivated as well?

Two things. The way media in the 21st century depicts nurses and doctors is one.

The second thing is that throughout thousands of years of human history doctors may have been considered brutes with strong stomachs but they were not the most "undesirable" people in society as nurses always were. Therefore people do not recoil so much at the idea of a doctor being respectable.

"I think I am going to start a "Leave the nurses alone and take a goddamn look at the conditions that they are working in, you fucktard" group on facebook."

I'll join your group. I got a gob full last week off a 'normally respectable' woman (relative) who was stood in the cubicle doorway watching the scene in the A&E dept on an extremely busy night. Like Beruit it was.

Her relative was the well-est patient in the department. She watched doctors and nurses running in and out of a cubicle with bags of blood and all sorts of high-tech equipment. She watched me fly into resus with a baby, shouting for help, fighting my way through ambulance crews and patients in the corridor on route. People collapsing all over the place, other people screaming out in pain waiting for pain relief, nurses RUNNING around like mad to attempt to keep everyone alive and safe. She COULD SEE with her own eyes what was going on. But still chose to 'scream' at me when asking how long they were going to have to wait.

Why scream at me??? Why?!?! She was a 'normally respectable' woman. I know she was worried about her relative, I understand that, I really do. But why scream at the nurses when you can see the ridiculous conditions they are attempting to manage. I attempted to pacify her more than once - with explanations that any normal person couldn't really argue with. But...oh no, no. Not the NHS patient/relative... They only see what they want to see. Bollocks to the other patients.

These assholes walk onto a ward (or an A&E) and they fucking SEE that the nurses are overloaded.

Do they really think that 2 nurses on a ward of 21 patients could really get around to everyone, spend enough time for everyone, and do everything that needs to be done for everyone? It should be obvious that this isn't going to happen. It should be obvious that it is going to take me 3 hours to get everyone their 8AM medicines. It should be obvious that even when I am giving 110% that people are going to have to wait hours for things.

But they are all crazy and don't want to face facts.

Management knows that they will just blame the nurses and that they themselves will get off scot free.

Anne, you are right on the money, every time. Nurses are expected to be both humble and obedient servants AND skilled professionals (patients/families are outraged when we don't answer the call bell soon enough -in less than thirty seconds- but they are also none too pleased if we administer an inappropriate medication AS ORDERED BY THE PHYSICIAN, we are supposed to (and do) know better). I did not study to become and am not licensed to be a servant. Yet servant I am. Physicians, on the other hand, are WORSHIPED, despite their average intelligence. Medicine is awfully science-y sounding these days, but the truth is (in practice) medicine remains more art than science. Scientists, who are the ones largely responsible for medical progress, get very little credit and (compared to physicians) minuscule paychecks. Nursing is BRUTAL and I have to find a way out because it is KILLING me. Period.

It is Brutal. There is no other way to describe. I have submitted my resignation 4 times now, and been on this blog saying "ha ha I am gone". But you get sucked back in. It's like going back to an abusive relationship because you "love him".

I nearly collapsed on the ward screaming on Friday. I had a patient going bad and I couldn't even get to him due to being bombarded with questions and interruptions (mostly from relatives) and when I did get to him I couldn't concentrate on what I was doing because the patients in the next bed saw me and started shouting for their cupboards to be organised and stuff. I nearly made a fatal mistake.

The thing was, I was the only nurse so all the MEDS, PROBLEMS, LABS, FOR THAT GROUP OF PATIENTS FELL TO ME ALONE. More was happening with that than I could keep up with despite running around like a headless chicken.

I did however have a gaggle of healthcare assistants. Why couldn't the patients go to them with the "organise my cupboard right now" stuff? It's not like the care assistants could take over the complicated stuff while I was off playing servant.

But you cannot explain this to the patients without them jumping up and down and accusing you of being a twat who doesn't want to be bothered with "caring". Therefore there is no point in pointing out to them who is the care assistant and who is the goddamn nurse.

For fuck's sake, I would bring a lawsuit against your hospital/government for reckless endangerment (of your license and of your patients)! It *is* very much like an abusive relationship. You are the victim yet you get blamed for any 'shortcomings' in patient care. Find some way to get the situation in the news -- the papers, television, everywhere -- before a (preventable) death happens. It's inevitable. And YOU are the one who will be crucified.

Going to the media will solve nothing. I'll be made out to look like a liar. I'll lose my job and get blackballed. The story will die down. It's not just my hospital that has this going on.

The layout of my ward is such that no matter where you are, the patients and visitors and everyone can all see you at all times no matter where you are. It's like being in a fishbowl and you cannot go more than a minute without "excuse me, can you sit my father up in the bed".

There is no time set aside for the nurses to get on with it uninterrupted. Even outside of visiting hours. We cannot even read the notes at the nurses station or stand at the end of the beds assessing and doing flow sheets without all the patients in the next beds immediately on us simultaneously with requests.

I have emailed and tried to write in the "readers comments" every time The Times, The Guardian, The Daily Mail et al write some garbage report about nurses being "too posh to wash" and "not caring" Not once have I had a response. My "readers comments" are often not published. They'll publish the Bring Back Matron readers comments.

If journalists really wanted to do some "investigating" they'd tell the truth. Because of the articles I've read about nursing in the UK I don't really trust any of these papers to be a valid source of truth. I'm unsure as to why they don't want to tell the truth.

The papers are all perpetuating the story that nurses are all lazy.

The UK definitely needs a Suzanne Gordon figure that would expose all this stupidity.

Once the game is 80% complete you will need to work on the sound. A bowler who can consistently pick up his spares can easily hold a 180 average without getting any strikes. Next Jim Deacove developed a few of his own board games based on the principles of cooperation, group strategy and joint problem solving.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.